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HOW TO AVOID SHORT FALLS WITH YOUR MEDICAL AID
Medical aid shortfalls can be a major financial burden for many medical aid members. This occurs when your medical aid pays less than what your doctor charges, leaving you with a bill to pay. These shortfalls can be avoided if you take the right steps. Follow these steps and you will be on the right path:
1. Choose the Right Medical Aid Plan for your needs
This is the first step in avoiding shortfalls. Different medical aid plans offer different levels of cover, so it's important to choose a plan that meets your needs. Look for a plan that covers the treatments and procedures you're most likely to need and one that has a reasonable co-payment structure. Make sure you understand the plan's limits and exclusions as this can be a huge burden.
2. Understand Your Benefits
Understanding what you took is a very important aspects that many clients avoid. This includes understanding the treatments and procedures that are covered, as well as any limits or exclusions. Make sure you know how much you can claim for each benefit and what co-payments you may need to make.
3. Use Network Providers
Another way to avoid medical aid shortfalls is to use network providers. These are healthcare providers that have agreements with your medical aid to provide services at agreed-upon rates. By using network providers, you can avoid the risk of being charged more than what your medical aid will cover. Check on the website or on the brochures available to find out which providers are in their network.
4. Get Pre-Authorisation
Before undergoing any treatments or procedures, it's important to get pre-authorisation from your medical aid. This involves submitting a request for the treatment or procedure, along with any necessary documentation, to your medical aid for consideration. Pre-authorisation is not a guarantee of payment but allows the member to get a better understanding of what may or may not be covered by their medical aid.
5. Negotiate Fees
If you're facing a medical aid shortfall, it's worth trying to negotiate fees with your healthcare provider. Explain your situation and ask if they're willing to reduce their fees or offer a payment plan. Many healthcare providers are willing to work with patients to find a solution that works for both parties.
6. Invest in Gap Cover .
Gap cover, otherwise known as medical shortfall cover, is designed to cover the shortfall between what your medical aid pays and what your healthcare provider charges. It can provide you with much needed additional financial protection and peace of mind. Get quotations form different companies to make sure you have the best cover and premium.
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